WHO speaks out on health security on World Health Day

"Invest in health, build a safer future", the WHO said in a new publication honoring this World Health Day, April 7^th. In the face of rising temperatures and globalization, the international health organization looks to the increasing threats to health. The publication outlines its primary focus areas:

1. Emerging diseases;
2. Economic stability’s effect on mobility of people and goods, and consequently diseases;
3. Humanitarian emergencies, for example Hurricane Katrina;
4. Biological and chemical terror threats;
5. Climate change;
6. HIV/AIDS;
7. Building health security;
8. Strengthening health systems.

The WHO continued, saying, after the Security Council met to discuss HIV/AIDS in 2000, “public health was no longer seen as irrelevant to security or as its by-product; it had become its essential ingredient.”

The call was echoed by many around the world. Dattatreya Bant, a professor of community medicine at Karnataka Institute of Medical Sciences explained the specific links between health security and health to the Times of India: "They include sudden shocks to health and economies from emerging diseases, like SARS (severe acute respiratory syndrome) and avian influenza, humanitarian emergencies, bio-terrorism and other acute health risks."

Bant also commented on the challenges to health common across the world: "The shortage of safe drinking water and its impact on health and security after hurricane Katrina in USA, and the tsunami in Asia, clearly demonstrate the importance of advance preparation and the ability to respond quickly."

An editorial in The Rising Nepal commented, “As defined by the WHO, health is a state of complete physical, mental and social wellbeing, and not merely an absence of diseases or infirmity”. It went on to emphasize the commitment that is necessary to achieving this wellbeing:

“There are political and institutional obstacles to optimally utilizing these trained human resources in their actual field of interest and expertise…There is no doubt that an effective public health workforce is extremely important to improving the health system …It is increasingly realized that this requires a substantial commitment to a new and creative approach from all countries and donor agencies.”

“Shackles” or “budget allocations”?

On March 30, the Institute of Medicine released a report called, “PEPFAR Implementation: Progress and Promise” which evaluates the initiative’s progress over the last three years. The interpretations of this report have been as mixed as those of the controversial initiative itself:

The New York Times focused on the IOM’s assertion that the fight against AIDS is “hampered” by certain restrictions in the plan, in particular:

1. the requirement that 33 percent of all prevention money be spent on teaching abstinence (and nearly 60% of all money for the prevention of sexual transmission)
2. that the FDA must approve AIDS drugs already approved by the WHO
3. that the program cannot sponsor clean needle exchange programs using taxpayers’ money.
   The article stresses IOM’s call for a more sustainable approach and less emergency response, and ends with the critical fact that at the half-way point of PEPFAR, the program has not met its goals.

The Boston Globe also focused on the obstacles to the US effort to fight AIDS, citing the funding restrictions and the report’s call for greater emphasis on prevention.

The Washington Post took a more positive slant, referring heavily to the reports statements that the program has made a “strong head start” and PEPFAR’s success at treating pregnant women, but also cites the report’s call for less prescriptive budgeting.

So does the IOM’s report “please almost everyone” as the Washington Post says?

Mark Dybul, who oversees the implementation of PEPFAR, was thrilled, welcoming the report as “an endorsement of our program”. In response to the critique on the prevention programs he said “There is no abstinence-only provision. I wish people would stop calling it that. It’s abstinence until marriage.”

According to the New York Times Dybul also disagreed with the report that PEPFAR should pay for clean needle programs. “Needle exchange just continues the condition” Dr. Dybul said. This, of course, contradicts with the Institute of Medicine’s recent review of the effectiveness of needle exchange, and the endorsement of needle exchange programs by the AMA, APHA, the American Academy of Pediatrics and numerous other groups.

While many PEPFAR critics were glad the report highlighted a need for a less “cookie cutter” approach to HIV prevention, tailoring responses to the epidemiology and emphasizing evidence-based approaches, others felt the report pitted prevention against treatment. Gregg Gonsalves said “If one needed more evidence that the pendulum has swung away from access to treatment and back towards the pre-2000 conventional wisdom that poor people can't be and shouldn't be treated with ARVs, the New York Times article today on PEPFAR just confirms” it.

The news coverage also gave little coverage of one of the major findings of the report – that more attention must be paid to factors making women and girls more vulnerable to HIV infection, and that PEPFAR must invest greater in efforts to improve their legal, economic, educational and social status. "We are making the overall recommendation to find ways to empower girls and women and to protect them from sexual harassment and sexual violence," the panel's chairman, Jaime Sepulveda of the University of California at San Francisco, told reporters.

This recommendation led many activists to call for passage of the PATHWAY bill re-introduced by Congresswoman Barbara Lee (D-CA) and Congressman Christopher Shays (R-CT) on March 27. The bill would require all HIV prevention programs funded by the President’s Emergency Plan for AIDS Relief (PEPFAR) to address violence against women and would eliminate the earmark for abstinence-until-marriage programs (Read more).

HIV/AIDS in Honduras

Honduras is one of the poorest countries in Latin America and one of the hardest hit by HIV/AIDS. The adult prevalence rate is estimated at 1.5 percent. Only Belize, with a prevalence of 2.5 percent, has a higher prevalence in all of North, Central, or South America, according to UNAIDS.

I would like to highlight a couple places that are hard at work to curb the epidemic and improve the lives of Hondurans living with HIV and AIDS.

In 1995, Siempre Unidos ("Always United") formed as the first self-help group for persons living with HIV/AIDS in Honduras. Its scope expanded over the years and it now follows the mission of providing life-saving outpatient medical treatment, social support, and education to people living with HIV/AIDS in Honduras. It receives help from the Global Fund, the Episcopal Church, and the Honduran government and now provides free anti-retroviral treatment to hundreds of people living with AIDS in San Pedro Sula. It continues to hold support group meeting once a week for over 100 people and also provides employment opportunities for HIV-positive women at its sewing factory, SiempreSol.

Fundacion Llaves began in 1999 to assist people living with HIV/AIDS in Honduras who were unable to obtain adequate information about their condition. Upon realizing that most of the information in Honduras pertained to prevention, Fundacion Llaves’ primary mission became to disseminate information for people living with HIV/AIDS—about health, the treatment options, and human rights. To this end, Fundacion Llaves reaches out to the press, the government, and the community to raise awareness. They publish a magazine called “Llaves” and a weekly radio program “Aprende del VIH/SIDA y Gana” (Learn about HIV/AIDS and Gain). With only 8 people, the organization has made significant gains for Hondurans living with HIV/AIDS.

HIV Testing and Reproductive Choice – How Did The Rights-Based Approach Play Out?

While this reflection is of the International AIDS Conference in Toronto - the tough questions it raises remain as pertinent (and largely unanswered) today as they were 6 months ago.

Published on RHRealityCheck.org (http://www.rhrealitycheck.org)

By Maria de Bruyn
Created Aug 28 2006 - 8:20am
Any reflections on the XVI International Conference on AIDS are necessarily subjective, as each person reporting attended different sessions, had different goals and talked to different people at different times. Nevertheless, taking the various perspectives into account can give us a more comprehensive view of what transpired in Toronto.
Advocates for women’s and rights issues can rightly take pride in having focused at least some attention on topics that were relatively neglected, such as female-controlled (at least to some extent!) barrier methods (female condoms, microbicides, diaphragms and cervical caps) and violence against women.
One hot topic that was debated in formal and informal sessions was the current push by national and international agencies to have as many people tested for HIV as possible. Most people agree that knowing one’s HIV status can have many benefits, not the least of which is enabling a person to seek appropriate treatment in a timely manner (assuming that affordable treatment is available within a reasonable distance from their place of residence, of course). What concerns those who question the speed with which testing initiatives are being expanded is whether this public-health measure will be based on respect for individual human rights.
Some worry that routine offers of HIV tests by health-care providers may easily turn into routine imposition of HIV tests for patients who are not knowledgeable or confident enough to ask about the benefits and risks associated with tests. (And just think about it – how often have you asked your physician all the questions you had about a medical exam, procedure or prescription? Have you never felt just a little intimidated or reluctant to challenge or question what your doctor says? I know that it’s happened to me and my well-to-do, highly educated, empowered female friends; women raised to be subordinate will have even more problems with this.)
The growing shortage of health-care workers in many areas means that health systems don’t have adequate staffing levels to ensure that patients can give informed consent or receive counseling. Inadequate infrastructure can mean that confidentiality is not ensured as no separate spaces are available where people can receive test results in privacy. Or people’s confidentiality is breached later when they can only access antiretroviral therapy (ART) at offices labeled “AIDS Services,” “ART for adults” and “ART for children.” When women are asked to take HIV tests during labor and delivery, they will often be in a ward with others – how can protocols ensure that their consent is informed and private? And how well can they consider benefits and risks at such a time?
At two different sessions on testing and counseling, speakers highlighted the increased numbers of people tested through Botswana’s provider-initiated testing system. However, it was only in response to an audience member’s question that one scientist admitted they were only now starting to consider evaluations that might also assess client satisfaction, access to ART and possible negative impacts subsequent to testing.
The ATHENA Network and International Community of Women Living with HIV/AIDS (ICW), with assistance from the Center for Health and Gender Equity (CHANGE), organized a press conference to highlight the need to examine testing from a gender perspective. For example, the experiences of ICW members point to the fact that “Testing services often do not address the stigma, discrimination and related violence, and loss of livelihood that many women face if their status becomes known. This makes seeking treatment and care a devastating prospect for many.”
The questions raised about the push for testing were good and necessary. What we need to hear about as soon as possible, however, is how the challenges to human rights-based testing and counseling are being tackled. Just a few examples (there are more!). Many physicians are coming to Africa from other countries to help deal with the health-care worker shortage (e.g., from Cuba). How well can doctors who don’t speak local languages ensure that people are able to give informed consent for a test? A study coordinated by Ipas on meeting HIV-positive women’s health needs recommends that women living with HIV be paid as counselors, instead of having them supplement health services as volunteers. Health-care workers in Argentina confirmed that HIV-positive counselors can offer superior services – how many testing programs are taking this approach? How do testing protocols take into account follow-up of people who tested positive (e.g., in accessing ART if needed or in providing treatment and support for mothers and children)?
Regarding reproductive choice: in 1992, when ICW was founded, the network published 12 statements on what was needed to improve the situation of women living with HIV/AIDS; one of those statements was: “The right to be respected and supported in our choices about reproduction, including the right to have, or not to have, children.” In the 2002 Barcelona Bill of Rights, ICW and other organizations stated that a fundamental right for women and girls around the world is “to sexual and reproductive health 1 services, including access to safe abortion without coercion.” So is reproductive choice receiving attention at the AIDS conference?
Some state that it was scarcely addressed; that is certainly true, for example, in comparison to prevention of perinatal transmission. But a few small steps forward have been made if we consider that the topic was virtually ignored in the past. About 20 poster and CD-ROM abstracts included the topic of pregnancy termination or integration/linking of HIV/STI and abortion services; several called for access to safe abortion services or noted how current laws create obstacles for women.
Of course, many people will not read the abstracts and did not see the posters. So was the topic visible otherwise? The T-shirts given away to participants in the Women’s March and Rally (the first to be officially endorsed by an AIDS conference) featured the Barcelona Bill of Rights, including access to safe abortion. Buttons distributed by the ATHENA Network and Blueprint Coalition asked for “sexual rights, reproductive choice and healthy motherhood.” And in an opening plenary speech on the first day of the conference, Louise Binder highlighted the need for women to have access to safe abortion for all indications permitted by law. Now we need to ensure that the 2008 International AIDS Conference includes at least one oral abstract, round-table or panel discussion session on reproductive choice with discussion of issues such as antenatal care for women who choose to become pregnant after knowing their status, access to safe abortion and integration/linkage of postabortion care services into HIV/AIDS information and services, coercive abortion/sterilization as human rights violations, and the possibility of adoption for HIV-positive parents.
One final observation: Louise’s plenary was the final one on 14 August and previous speakers had exceeded their allotted time. This resulted in many delegates leaving the session to go to the next one; considerable numbers of women also left the room before hearing the presentation on women and HIV/AIDS. When her presentation went a bit long, the chair of the session (a woman!) cut off her microphone. To her credit, however, Louise stood her ground, refused to budge and was supported by remaining delegates so that eventually her microphone was turned back on and she could finish. The most insulting thing about this was the chair’s admonition that Louise had to conclude because the next session was about to start and included “important people – Bill Clinton and Bill Gates.” Now what does that say to us about women having a fully recognized and meaningful place at the table??
Some references:
ATHENA Network: http://www.athenanetwork.org 2
ICW press release on testing: http://www.icw.org/node/211 3Ipas study: http://www.ipas.org/publications/en/MDGMON_E06_en.pdf 4
Source URL:http://www.rhrealitycheck.org//blog/2006/08/25/hiv-testing-and-reproductive-choice-how-did-the-rights-based-approach-play-out
Links:1 http://www.rhrealitycheck.org/glossary%23Reproductive+Health2 http://www.athenanetwork.org/3 http://www.icw.org/node/2114 http://www.ipas.org/publications/en/MDGMON_E06_en.pdf

McCain Stumbles on H.I.V. Prevention

Monday, March 19
"The unthinkable has happened. Senator John McCain met a question, while sitting with reporters on his bus as it rumbled through Iowa today, that he couldn't -- or perhaps wouldn't -- answer.

Did he support the distribution of taxpayer-subsidized condoms in Africa to fight the transmission of H.I.V.?

What followed was a long series of awkward pauses, glances up to the ceiling and the image of one of Mr. McCain's aides, standing off to the back, urgently motioning his press secretary to come to Mr. McCain's side."
--Adam Nagourney, NYTimes Blog

Read the full story at:
McCain Stumbles on H.I.V. Prevention
MediaMatters for America

International Women's Day

Just in time for International Women's Day this year, the Women Won't Wait campaign launched a timely report recognizing the intersectionality of violence against women and HIV/AIDS. "Show Us the Money: Is Violence Against Women on the HIV&AIDS Funding Agenda?" by an international coalition of human rights and health organizations, calls for changes in the policies, programming and funding streams of national governments and international agencies.

Other IWD information:

International Women's Day 2007

Women's E-news

Human Rights Watch: Women's Rights Division

Margaret Chan, Director-General of the WHO, discusses the importance of promoting women's health this International Women's Day:

"On International Women's Day, I invite you to join me in celebrating women worldwide. Women are the backbone of all our societies - as leaders, as caregivers, and as mothers. Yet on this day and every day, we remember that too many women in the world lack access to the most basic health care.

Women have particular needs and face specific health issues. However, the health needs of women are given neither the attention nor the prominence they deserve. Each year, for example, more than half a million women die from complications related to pregnancy and childbirth alone - a number that has hardly changed in 20 years. In 2006, 74% of people living with HIV in sub-Saharan Africa were young women.

This year's International Women's Day is devoted to ending impunity for violence against women and girls. We know that intimate partner violence is the most common form of violence in women’s lives - much more so than assault or rape by strangers or acquaintances. The high level of physical and sexual violence committed by an intimate male partner has shocking consequences for women's health. Furthermore, one in five women reports being sexually abused before the age of 15, which is associated with ill health for years to come.

The health of women is given far too little space in plans for development and too little attention in many health agendas...."

Read entire statement

Update: Dr. Gao will travel

Earlier today, Chinese officials finally granted AIDS activist Dr. Gao Yaojie permission to travel to the United States next month to accept her award from Vital Voices, reported the AP/New York Times (http://www.nytimes.com/aponline/us/AP-China-AIDS-Whistleblower.html).

For the last week, Dr. Gao has been confined to her home in the Henan Province by Chinese officials pressuring her not to travel to the US. The 80-year-old doctor has been instrumental in exposing the harsh realities behind China's AIDS epidemic, which the Chinese government would rather leave hidden. After heavy pressure from international groups during Dr. Gao's detention, the Chinese government reportedly told the US embassy: "We will abide by her decision to come."

Read more about the Chinese government's efforts to cover up the detention itself:
"China Covers Up Detention of AIDS Doctor", February 16th, http://www.nytimes.com/2007/02/16/world/asia/16china.html

Women, HIV/AIDS and Human Rights Skills Building Workshop held in Toronto August 14-17, 2006.

CURRICULUM with ANNOTATED BIBLIOGRAPHY and CASE STUDY available online!

Online athttp://www.law-lib.utoronto.ca/diana/women_hiv_aids/contents.htm

Table of Contents
1) Overview Articles

2) Sex, Gender & Social Context in the HIV/AIDS Pandemic
(a) Stigma, Discrimination, and Violence
(b) Gender, Sexuality, and HIV/AIDS
(c )Criminality and HIV/AIDS
(d) Sex Trade Work
(e) Women's Property and Inheritance Rights
(f) Orphan & Vulnerable Children in Changing Family Structures
(g) Neglected Population: Indigenous & Aboriginal Women

3) Challenges in Access to Prevention Treatment and Care
(a) Women and HIV Testing
(b) Sexual Violence
(c) Access to Post-Exposure Prophylaxis
(d) Access to Microbicides & Other Female-Controlled Prevention
(e) Access to Reproductive Health Services, including Abortion
(f) Neglected Population: Adolescent Girls
(g) Evidence-Based Practices and Policies
(h) Community and Family Based Care
(i) Gender Dimensions of Health Rationing

4) Accountability, Advocacy & Documentation

CASE STUDY:Treatment Action Campaign v. The Minister of HealthA case decided in 2002 by the Constitutional Court of South Africa whichfound that pregnant HIV-positive women had the constitutional right tomedication to prevent mother-to-child transmission of HIV.
Online at: http://www.law-lib.utoronto.ca/diana/casestudies.html

CURRICULUM of our Spanish workshop held August 17,“Mujeres, VIH-SIDA y derechos humanos: explorando las intersecciones”,see the RED ALAS website:http://www.red-alas.org/click on: “Publicaciones”then click on: "Capacitación”

ICW: Reproductive Rights and Wrongs

The International Community of Women Living with HIV/AIDS (ICW) is the only international network of HIV positive women and has 5000 members worldwide.

Our vision is a world where all HIV positive women:
Have a respected and meaningful involvement at all political levels, local, national, regional, and international, where decisions that affect our lives are being made;
Have full access to care and treatment; and
Enjoy full rights, particularly sexual, reproductive, legal, financial and general health rights;
Irrespective of our culture, age, religion, sexuality, social or economic status/class and race.

Here we feature the story of Sthemiso, an ICW member, whose experiences powerfully illustrate why the sexual and reproductive rights of HIV positive women are a key focus of ICW's advocacy work and communications.

For more information about ICW's work and for copies of publications please see www.icw.org . Or get in touch - info@icw.org.



My Story of Motherhood: Reproductive Rights and Wrongs

We all know that life circumstances change and feelings shift. Perhaps something that you felt certain about five years ago is not necessarily so certain now. Sthembiso* tells us the story of her daughter, born when she was only a girl. She describes the stigma of being the HIV positive mother of a disabled child who she now knows is also HIV positive. She explains why previously she did not want another baby. Today her life is very different and she longs to have one.

'For me motherhood is a complex issue. I have an HIV positive child who has another, completely separate disability. I feel guilty each time I talk directly about her. My daughter was born in 1993. In 1996 I had a stillborn child. In 1998 I had a termination of another pregnancy and was pushed into being sterilised. At the same time I was living with no hope for treatment, had an abusive partner, and was jobless with no real home of my own. At that point I would have said I absolutely did not want to have any more children.

When I went into labour we were building a little mud house outside the main house. When I felt the pain and saw things coming out I told my mother but she insisted that I work even harder. I had to fetch and carry a 25-litre container of water from the tap at the main house. (That mud house is where my daughter and I ended up sleeping because my mother did not want the noise of the baby to disturb her.) I worked the whole day mixing the mud, fetching the water and cooking. According to my mother this was to help the labour process. Obviously I couldn't complain – I had committed the worst sin ever by falling pregnant at 16 without being married. My parents were doing me a favour keeping me at home when they could have rightfully kicked me out. After 3 pm when the pain was unbearable my mother allowed me to have a bath and to
take a taxi to the clinic – on my own. When I got there they shouted at me for arriving late.

After being examined they called an ambulance – I needed medical attention at the hospital. But the baby came before the ambulance. She was a girl and she did not cry – I was told she was too tired. Finally we were ferried to hospital where she was kept in the nursery for five days. I only learned nine months later that loss of oxygen at birth caused her disability. I do not want to blame my mother but there is a part of me that says if she had not made me work so hard, things would have turned out differently. Had she sent me to the clinic earlier my daughter would probably not be disabled. I would have felt better had she at least accompanied me to the clinic. I do not know why I am writing this. It is the first time I am actually acknowledging this
disturbing reality of my life.

Changes and challenges

My life has changed now. My daughter is almost 15. She is in care after I realised it was the best option for her as her needs are becoming more complex the older she gets.

It was after coming to terms with my HIV diagnosis, meeting other women in similar situations, and beginning a new life, that the desire to have another child cropped up. Having another child (if I do have one) would give me the opportunity to enjoy being pregnant by choice and to be a mother in different circumstances. I think of my daughter too; I am her only family. What will happen if I die? I would pass on peacefully if I knew that I was not leaving her alone no matter how long it took her sibling to grow enough to understand there is a sister who needs love and nurturing.

My desire for another child has thrown up many challenges. The first is to get a partner. I am in my 30s, have HIV, a disabled child, and I am a feminist. HIV helped me to discover myself as a woman and I am finding it really hard to find and keep relationships with men. I have explored in vitro fertilisation (IVF) as an option. It turns out that male partner participation in treatment is essential. One boyfriend agreed to take the treatment with me. However, he refused to go for a fertility test, arguing that he did not need to as he already has children. In the end he went after I negotiated and traded off a fair degree of my power in the relationship. The results showed that his sperm count was low and he needed fertility treatment for the IVF to
be successful. He did not receive the news very well, and he blamed me for bringing it to his attention. A couple of months later the relationship was over.

The question is, do I wish to meet another man and tell him my story, beg him for his sperm and loose some power in the process? The answer is, I would rather not, but what choice do I have? Maybe I should try the sperm bank, but will they take me if I disclose my HIV status?

Pain and Joy

All those years ago when I was sterilised I felt as though I was being punished and judged. I did not want to have a child then. But I did not want to be sterilized either. Recently my doctor suggested that perhaps we could reverse the sterilisation. Two weeks ago I learned
with shock that the sterilisation was irreversible. I am still dealing with this. I have not lost hope. I will continue to explore the options and the possibilities I have.

I draw strength and support from a woman living with HIV who is in a similar situation. We talk and cry over the dramas as they unfold. I always claim my case is the worst, but she tells me no, because she is married and hasn't told her husband she was sterilised. If she had revealed this, her husband's family would not have paid lobola (bride price) for her. She is worried about what will happen to her if she discovers her sterilisation cannot be reversed either, as this is her only solution.

As I live and grow with HIV, I see other women with HIV having healthy children. I feel joy and pain when I learn that someone has had a baby. I do not go anywhere near baby shops. I avoid places with infants.

I love my daughter very much, I love her gorgeous smiles, I enjoy the way she creatively uses her body to communicate her needs, wants and emotions with me using MAKATON (a communication technique she uses as she cannot speak). I enjoy the way she propels her wheelchair to dangerous places in the house to attract my attention, the way she is self-aware, how she will not take on another activity before you clean her hands, how she will behave when she sees another disabled child, how she is when I am with her alone or with her carers and teachers, how she learns and copies games from able-children and imitates them using the abilities she has, and how she recognises anything said and sung in her home language Zulu although she has not spoken or lived in a community that speaks the language in years. I love the way she portrays my character and how our interests and behaviour are the same sometimes. I love reading her school reports. Dear daughter. I cannot begin to say how grateful I am that she's almost fifteen. My daughter and I are very lucky. I know many children in her situation no not have access to what she has.

HIV has become less of a worry as far as my desires are concerned. I am on treatment and receive high quality care. All my medical professionals are supportive. My state of health is excellent. Unlike many women, I have access to information, services, resources and support. For me the most stigmatising thing was having a disabled child and having HIV. Now with support and love from other HIV positive women, and professionals, I am surviving that double stigma. There is no way I could be brought down by the stigma of being HIV positive and pregnant.'

(Source ICW News 34 -please link to http://www.icw.org/files/ICW%20English%2034%20Web.pdf)

*Sthembiso's name has been changed

Intensive course in Health and Human Rights

Intensive Course in Health and Human Rights:
June 18-22, 2007 Boston, Massachusetts

Learn How to Incorporate a Human Rights Framework Into Your Professional Activities

Presented in Collaboration with:

• The Boston University School of Public Health, Department of Health Law, Bioethics and Human Rights
• The Harvard School of Public Health, Department of Population and International Health

This rigorous 4.5-day program helps a wide range of professionals acquire the skills and knowledge they need to successfully incorporate a human rights framework into their daily activities. Participants will acquire a basic understanding of both the history and present status of international human rights and international humanitarian law as they apply to public health practice. The faculty will show participants how to:

· Analyze the human rights dimensions of public health policies and programs
· Access international mechanisms and procedures to further the human rights of persons whose health status is threatened

About the Program:

Expert faculty members create a dynamic learning environment in which a large body of material can be covered in a short amount of time.

The program progresses from general to specific topics:

· Basic Concepts of Health and Human Rights
· Application of the Human Rights Framework to Public Health Policies and Programs
· Skills for Putting the Health-Human Rights Linkage into Practice
· Institutional Settings for Linking Health and Human Rights
· The Way Ahead: Making the Health-Human Rights Linkage Work

Program Format:

Small group settings provide further opportunity for direct interaction with the faculty and with your fellow participants. Repeated offerings allow you to attend more than one session of interest. The individualized attention you receive in the Intensive Course in Health and Human Rights will help you formulate your strategy for implementing newly acquired knowledge and skills in your professional work as well as provide invaluable networking support.

Learn more at: http://sph.bu.edu/index.php?option=com_content&task=view&id=556&Itemid=692#Program%20Fee

Update: Global Fund names Executive Director

The Global Fund selected Michel Kazatchkine to replace Richard Feachem as its Executive Director. Kazatchkine has spent much of the last 20 years working on HIV/AIDS, both as a physician and as the leader of an AIDS research agency. Feachem's term ends on March 31, 2007.

Read more about the Global Fund's selection and Professor Kazatchkine:
Global Fund
Boston Globe
Agence Nationale de Recherches sur le SIDA

AIDS doctor detained by Chinese officials

Dr. Gao Yaojie, a 79-year old Chinese doctor who has been internationally recognized for her fight against the spread of HIV, has been detained by Chinese officials since Thursday, February 1st. Dr. Gao was scheduled to arrive in the US this week to accept an award from Vital Voices. As of Feb 6, Dr. Gao has been under house arrest in Zhengzhou with no access to modes of communication.

Dr. Gao spent her retirement traveling around Henan Province, spreading information about AIDS and distributing medicine. She was instrumental in exposing how a blood-selling program in central China infected thousands of people with HIV in the 1990s. She was been nominated for a Nobel Prize and has been awarded several international prizes, such as the Jonathan Mann Award for Global Health and Human Rights in 2001, and she was nominated for a Nobel Prize in 2005.

Dr. Gao has been repeatedly prohibited from traveling abroad. This time, according to news reports and AIDS activists within China, Henan officials went to her house to warn her not to travel to the US where, in addition to accepting her prize from Vital Voices, she was scheduled to hold meetings with politicians and advocacy groups in Washington.

Dr. Gao has taken extraordinary risks to expose the scope of the AIDS epidemic in China. Although China has received increasing accolades from the international community for frankly addressing AIDS, her detention is a sad illustration that speaking openly and honestly about the epidemic is still threatening to officials within China.

More information on Dr. Gao Yaojie’s detention:
International Herald Tribune
Globe and Mail
Reuters

More information on Dr. Gao:
TIMEasia.com: Asian Heroes
PBS (1/3/07): China from the Inside
Women of China (12/12/05): “Gao Yaojie: a Crusader for AIDS Prevention”
China Daily (7/14/05): 108 Chinese grassroots women in race for Nobel
AFP (3/7/04): “China's AIDS whistleblower Gao Yaojie vows to continue helping sufferers”
The Peking Duck (2/26/04): “China's leading AIDS activist Gao Yaojie publicly honored”
Dr. Gao Yaojie: “My AIDS Prevention Journey” (5/1/01)

Other information on AIDS in China
Human Rights Watch’s Report: “Restrictions on AIDS Activists in China”
ABC News: “Stigma and Discrimination Fuel Spread of AIDS in China”
Letter to New York Times re: ''China's Muslims Awake to Nexus of Needles and AIDS''
Kaiser Network (1/06): “Estimated Number of HIV-Positive People in China Is 650,000”

Update: Global Fund Executive Director

Three finalists for the position of Executive Director of the Global Fund to Fight AIDS, Tuberculosis, and Malaria have been announced. Richard Feachem, who has been the Executive Director since 2001, will be replaced by either Michel Kazatchkine, France's HIV/AIDS ambassador; David Nabarro, a British national now leading the United Nation's efforts to fight avian flu; or Alex Coutinho, executive director of the AIDS Support Organization in Kampala, Uganda.

The Boston Globe followed up on this story.

Update: Médecins Sans Frontières to Novartis

Quarter of a Million People Urge Novartis To Drop Case Against India
Company Would Effectively be Shutting Down the "Pharmacy of the Developing World"

New Delhi/Geneva, 29 January 2007 – As pharmaceutical company Novartis proceeded with its legal challenge against the Indian government in a court hearing in Chennai, India, today, nearly a quarter of a million people from over 150 countries expressed their concern about the negative impact the company's actions could have on access to medicines in developing countries. The Indian Network for People with HIV/AIDS (INP+), the People's Health Movement, the Centre for Trade and Development (Centad), together with the international medical humanitarian organization Doctors Without Borders/Médecins Sans Frontières (MSF), called on the company again today to immediately cease its legal action in India.

The court hearing will continue February 15.

Read MSF's entire press release at: http://www.doctorswithoutborders.org/pr/2007/01-29-2007_1.cfm

Listen to the teleconference and see the transcript here:
http://www.doctorswithoutborders.org/news/access/novartis_teleconference.cfm

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Listen to Loon Gangte, participant in this press conference and Regional Coordinator of South Asia Collaborative Fund for HIV Treatment Preparedness (formerly from Delhi Network of Positive People), talk with Human Rights Watch: http://www.hrw.org/campaigns/aids/2006/toronto/audio2.htm

Update: Thailand to allow generic versions of Plavix and Kaletra

Thailand’s government, in a landmark decision today, approved the production of cheaper versions of two major medicines for heart disease and HIV/AIDS (Plavix and Kaletra respectively). The government took advantage of the World Trade Organization’s rules on intellectual property to declare a “national emergency”, allowing them to produce and sell already patented drugs.

Health Minister Mongkol na Songkhla has been widely quoted today for saying,“We have to do this because we don’t have enough money to buy safe and necessary drugs for the people under the government’s universal health scheme”. Ms. Kannikar Kijtiwatchakul of Doctors Without Borders commented, “It is a brave decision”.

Read more on this recent development in:
Bangkok Post
International Herald Tribune
BBC
Scientific American
Wall Street Journal
Business Week

Access to essential medicines

Lancet‘s recent editorial, “Undermining TRIPS: protectionism at its worst”, brings to light two international campaigns that will likely be of great signficance for the future of poor countries’ access to medicines. The campaigns, led by Doctors Without Borders and host of other organizations, are working to uphold the rules of Trade Related Aspects of Intellectual Property (TRIPS) agreement that allow, in certain situations, essential medicines in developing countries to be distributed at affordable prices. This agreement is currently threatened by large pharmaceutical companies that are taking steps to expand their rights to patent their medicines. Of particular urgency right now is a case pursued by Novartis, a Swiss company, against the Indian government, and a case led by Merck against the Thai Government.

These are important and complicated cases with implications for the future of free trade, public health, and human rights. Here is a list of important links—certainly not exhaustive—to provide background on the issue:

Novartis & India
"Novartis Challenges Indian safeguards"

MSF: Q&A on patents in India and the Novartis case

"MSF Urges Novartis to Drop Case Against Indian Government"

"India’s 2005 Patent Act"

Merck et al. & Thailand

Thai Health Ministry To Issue Compulsory License for Merck's HIV/AIDS Drug Efavirenz
MSF: Open Letter to Condaleezza Rice

Intellectual Property & Free Trade

WTO: TRIPS
“What are Intellectual Property Rights?”
The Doha Declaration
Declaration on TRIPS agreement and Public Health

“The FTAA, Access to HIV/AIDS Treatment, and Human Rights”, a Human Rights Watch Briefing Paper

Harvard Political Review: "Patients vs. Patents"

Listen to Sangeeta Shashikant, Researcher for Third World Network in Kuala Lumpur, comment on patents and access to generic medicines.

Boston Globe: Global Health Organization prepares to name leader

WASHINGTON -- The next leader of a global organization that fights major infectious diseases, including AIDS, may come from a group that includes the former health minister of Mexico, France's AIDS ambassador, the former leader of UNICEF, and several leaders of the World Health Organization, according to a list of names obtained by the Globe.

The board overseeing the organization, Global Fund to Fight AIDS, Tuberculosis and Malaria, failed to select a new executive director last November and now hopes to name one at a meeting in Geneva early next month.

Read this article at: http://www.boston.com/news/nation/articles/2007/01/09/global_health_organization_prepares_to_name_leader/

The two sides of opium

Afghanistan has a booming opium trade, which has increased seven-fold since 2002 and supplies an estimated 90 percent of the world's illegal heroin. Much of this goes to (or through) nearby Pakistan where injecting drug use is a main concern and HIV prevalence is rising. Recently, Pakistan's Health Minister expressed frustration at the Afghan government for not moving more effectively towards poppy eradication. The US eradication efforts since entering in 2002 have also been largely ineffective.

The WHO raises different concerns about Afghanistan's opium production: that it does not reach enough people worldwide for pain relieving purposes, causing a "world pain crisis". Opium is also the raw material for morphine. Developing countries as a whole only consume 6 percent of medical opioids yet by 2015 may have 10 million cancer cases. In the US, half of those suffering from chronic pain-most commonly AIDS and cancer patients-do not receive adequate pain relief. Pain relief worldwide is not only distributed unequally, but altogether insufficiently.

The Security and Development Policy Group (Senlis Council ), an international policy think tank with offices in Kabul, London, Paris and Brussels, has argued that the answer to Afghanistan's illegal drug trade is not poppy eradication, which: 1) deprives local farmers of a major source of income; 2) contributes further to the inadequacy of global pain relief; and 3) most likely will not eliminate the drug trade. Instead, it argues that the International Narcotics Control Board(INCB) license growing in Afghanistan. It is estimated that the price of buying the entire Afghan poppy crop would cost less than what the US is spending on eradication campaigns that have not worked.

The INCB's main function is to mediate exactly the dilemma that is presented in Afghanistan: balancing the medical needs of opioids while controlling illegal trafficking. The INCB has sent multiple missions to Afghanistan. They’ll outline their recommendations in their upcoming Annual Report to be released in February.

What will it say? Will it address only trafficking or also the need for more access to legal opiods?

Stay tuned.

Read more:
“There's a way to end Afghanistan's and the world's pain”

“Afghan drugs a worry as Pakistanis confront AIDS”

“Let a Thousand Poppies Bloom”

Parallel messages, similar results

A recent New York Times editorial on the ineffectiveness of Phillip Morris’ anti-smoking ads bears more than a little resemblance to current debates about abstinence-only education for teenagers.

We’ve all seen the Phillip Morris ads saying, “Think, Don’t Smoke” and recent ads target parents, telling them to warn their children against smoking. In short, “just say no”.

A recent research study published in the American Journal of Public Health found that the ads have had no beneficial effect on teenagers and that those aimed at parents actually had an encouraging effect on teenagers.

The study found a direct relationship between exposure to the ads and likelihood of smoking in the past 30 days.

The New York Times observed that “their theme—that adults should tell young people not to smoke mostly because they are young people—is exactly the sort of message that would make many teenagers feel like lighting up.” The Times also noted that the goal of the ads is not actually to prevent smoking for a lifetime, but to put it off until adulthood, and that the ads have no mention of the fact that smoking is addictive or even harmful.

Likewise with abstinence-only education. Nearly two-thirds of US high school seniors have had sexual intercourse and there were 822,000 reported pregnancies among women 15-19 years old in the year 2000. While there is no evidence to show that abstinence-only classes changes this, there is evidence to show that education about contraception and sexually-transmitted infections reduces risk-taking and pregnancy among teens (see PP, Kaiser, ACLU, Guttmacher). And if the goals of abstinence-only programs are the same as the anti-smoking ads—to delay intercourse until adulthood (i.e. marriage)—then we will still have rampant ignorance about STIs, protection, and reproductive health.

While the motivations of the two campaigns may be different (those behind the Phillip Morris ads are looking to keep sales (i.e. smoking) up while “avoiding a governmental crackdown” and those preaching abstinence-only arguably do want to keep teens from having sex), each scenario, through the evasion of straightforward conversation and disregard for proven studies, threatens young people with bitter ends: lung cancer and AIDS.

Signs of a new Congress: Questioning the roots of US HIV/AIDS policy

The Boston Globe reported yesterday on some important questions that Democrats are asking about President Bush’s faith-based initiatives:

• Have current faith-based initiatives violated the separation of church and state?
• Did the Bush administration really give 98.3 percent of the faith-based foreign-aid money to Christian groups? How does this affect, among other things, our foreign relations?
• What are the effects of such faith-based initiatives on our fight against AIDS?

Questions such as these are being articulated mainly by Representative Barbara Lee (D) from California and Representative William Delahunt (D) of Massachusetts.

Representative Lee is sponsoring a bill that would overturn a measure that requires that one-third of the money spent by the US government on AIDS prevention overseas go for "abstinence until marriage" programs. This is a $1 billion measure and many Democrats have suggested that the money could be better spent on other measures such as condoms. "When you look at what has been exposed and revealed, I think we have a factual basis to move forward with this," Representative Lee said.

Representative Delahunt, who will soon chair the International Relations subcommittee on Oversight and Investigation, said that if US-funded Christian groups work in Muslim-dominated countries, the effort could be "perceived to be proselytization and it can generate a harsh negative reaction that implicates and impacts in a negative way on America's image in the world and have significant consequence to our foreign policy goals."

Democrats are also attempting to repeal a measure that required US groups receiving faith-based funds to have a policy opposing prostitution. Many groups have said the pledge impedes their work with sex workers who are at high risk for HIV. Organizations have also raised a question of the constitutionality of the pledge as compelled speech. Two federal judges have ruled that the pledge is unconstitutional and the Bush administration has appealed these rulings. Read more.

Regarding the AIDS fight, Representative Tom Lantos, the California Democrat who will chair the International Relations Committee in January, said, "Our global HIV/AIDS policy should be about saving lives…It is inconsistent with this goal to place ideologically driven restrictions on the implementation of efforts to prevent spreading the virus."